Antares Selects DataDirect Shadow to Aid Real-Time Claim Adjudication

Antares Management Solutions, a business division of Medical Mutual Services LLC, is using a product called DataDirect Shadow, a single, unified integration architecture supporting mainframe SOA enablement and data integration, to integrate mainframe data into a service-oriented claims processing application, the companies report.

The product, from DataDirect Technologies—an operating company of Progress Software—will be used to improve the efficiency of medical billing and customer service.

The auto-adjudication technology was created specifically for Medical Mutual of Ohio and its TOPPS system. In an effort to address the business need to support physicians and providers with patient liability information in real time, Antares set out to build a robust claims processing application that would allow physician offices to submit claim information and immediately get processing results. The new Web-based application would allow patients to know, at the point of service, the total amount owed for the medical procedure.

To address integration and agility challenges common to modernizing legacy applications, the company adopted a service-oriented architecture (SOA) approach. The existing insurance claims processing application relied on mainframe green screens within the customer information control system (CICS) as the primary interface to access billing information stored within a mainframe DB2 database.

Antares sought a third-party technology that could transform the CICS screens into Web services to integrate the legacy billing application with the new online claims application—a fundamental step toward their SOA goals.